On March 27, 2012, 20 nurses from the Ocean Road Cancer Institute (ORCI) in Tanzania graduated from the first ever OncoLink Cancer Nurse Education Program, a pilot program started in February 2011 that aims to provide oncology nursing training in via e-learning courses. The program was created by oncology nursing experts at OncoLink®, a free cancer information website developed by experts at the University of Pennsylvania's Abramson Cancer Center.

The first graduating class from the OncoLink Cancer Nurse Education Program

With a population of nearly 40 million, Tanzania lies on the east coast of Africa between Kenya and Mozambique. The country sees roughly 21,000 newly registered cancer cases annually, of which more than half result in death. Located in the main coastal city of Dar es Salaam, ORCI is the only specialized center for cancer treatment in Tanzania. It provides both diagnostic and treatment services for cancer patients from all regions in Tanzania as well as other eastern and southern African countries. Of the 21,000 new cancer cases each year, only 10 percent reach ORCI. Of these, 75 percent to 80 percent are already in advanced stages, and, at the rate the number of cancer cases is increasing, cancer will likely be the dominant health issue in Africa for decades to come.

“We first learned about the cancer population in Tanzania and the ORCI at the African Organization for research and Training in Cancer’s (AORTIC) International Cancer Conference,” said James Metz, MD, associate professor and vice chair of clinical operations in the department of Radiation Oncology at the Perelman School of Medicine, who serves as editor-in-chief of OncoLink. “As we learned more about ORCI, we realized that there was this huge patient population, but the health care providers had this major dichotomy in the resources available. The nurses, for example, are an incredibly passionate group of people who are dedicated to their professions, but the education in oncology was almost non-existent. Additionally, though the ORCI had relationships with various organizations and received much of their technology from donations, they were lacking some of the most basic elements to provide quality care.”

Unfortunately for the thousands of cancer patients and their health care providers, there is no nursing oncology training in Tanzania or the surrounding areas. Most nurses at the ORCI are trained in general medicine and infectious disease, but not oncology. Additionally, despite the rising number of cancer patients, extremely limited funds within the country prevent the development of a curriculum of oncology training – a relatively new specialty in the country. Recognizing the need for more information and advanced training so they could provide superior care to their patients, nurses at ORCI asked OncoLink to provide them with education via e-learning techniques.

“We thought, ‘what do we do best?’ and that was easy – it’s education,” said Maggie Hampshire, RN, director of Strategic Partnerships and managing editor at OncoLink. “We were already working on a number of nursing educational programs, so when we learned of the need for this program at ORCI and really started to understand how deeply the doctors and nurses want to provide better care to their patients, we thought this would be a great pilot project that could really make a difference.”

After a period of careful development, during which ORCI and OncoLink worked together to determine the biggest areas of need and bridge the gap between language barriers and cultural divides, a program consisting of 20 modules in broad oncology training, was rolled out to ORCI nurses. Video modules were adapted from a certification review course for Oncology nurses offered at the Hospital of the University of Pennsylvania (HUP). Topics ranged from the science and biology of cancer, through the cancer spectrum, to end of life issues. With such limited means and an unreliable internet connection, Penn provided ORCI with three computers and programs delivered on CD for the nurses to carry out their training. Tests administered before and after each program were sent back to Penn for analysis. Quizzes were also given in between learning modules. The course was reviewed and certified by Larissa Shelton, MSN, RN, a professional development specialist at the Department of Nursing Education, Innovation and Professional Development at HUP.

Nearly two years after their first visit to Tanzania, and more than a year after the program roll-out, the OncoLink team returned to formally present the 20 ORCI nurses with a certificate of completion. The changes made not only to the level of patient care, but also to the hospital itself, were staggering.

“In less than a year, ORCI had completed construction on a new building, implemented new nursing care standards, installed a chemotherapy prep hood, and began the establishment of treatment guidelines,” said Hampshire. “The entire team at ORCI clearly made improving patient care a top priority in the last year, and we couldn’t be more impressed.”

As the first of what OncoLink developers hope will be many oncology nursing training programs, Hampshire said the trip to Tanzania was a great learning opportunity for all. “During our visit for the graduation ceremony, we met with several ORCI doctors and nurses to learn about how we can improve the program moving forward and continue to help ORCI. For example, the evaluation forms they filled out on the course mentioned that an email form so expert nurses at Penn could provide instant feedback to the ORCI nurses, and a written study guide for their nurses, would be helpful in their continuing quest for training.”

In a country that experiences rolling blackouts several times/day, a city built for 800,000 but is home to 4.5 million, and a hospital where almost 200 patients occupy a space with 100 beds, graduation day at ORCI was a welcome celebration.

“The doctors and nurses who greeted us at ORCI were incredibly grateful for the training they received through the program, and really let us know how much of a difference this will make in the way they care for their patients,” Metz said. “The resources available at Penn afford us so many opportunities to make a substantial difference to health care in developing nations, and we look forward to continuing our relationship with ORCI, and expanding the program so it will be broadly helpful to other African institutions.”

To learn more about OncoLink, or to make a donation in support of the OncoLink Cancer Nurse Education Program, please visit the Friends of OncoLink.

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